CalAIM reforms eliminates local choice for Medi-Cal patients

RIDGECREST REGIONAL HOSPITAL — RRH Rural Health Clinics are pursuing multiple pathways to restore the services and care of local providers to an estimated 10,000 patients who were reassigned to a Bakersfield-based network as a part of the Department of Health Care Services CalAIM reforms.

CalAIM (California Advancing and Innovating Medi-Cal) was adopted to improve management and quality outcomes. However, RHC Administrator Michelle Whalley noted that Ridgecrest has historically been exempted from managed care plans because of our geographic isolation.

“We have spent more than a decade building a network of local healthcare systems and providers to meet the needs of our community,” said Whalley.

When those patients learned that they were being swept up into a plan that moved them to a network that has only one small clinic here, and no onsite physicians, they began turning to Rural Health for guidance.

Whalley and her team immediately went to work trying to reverse the decision, ultimately presenting their case to a California Superior Court judge. A favorable ruling could restore the connection between local patients and their providers.

“Unfortunately, until this is resolved we have thousands of people who are unable to seek local services with the providers they have been seeing for years,” said Whalley.

A handful of patients have successfully wrangled the healthcare bureaucracy to shift their coverage back to the local clinics and providers. “But quite frankly, this is a complicated and time-consuming process. Not everyone has the time, the wherewithal, an understanding of the system — or even an awareness that this has happened to them.”

Whalley noted that many patients found out they had been re-assigned when their appointments for service were canceled or rescheduled, until their assignment could be restored to their RRH PCP.

“This has also impacted our patient’s relationships without specialty care clinics, for important services such as cardiology and oncology,” said Whalley.

“While we await an outcome in the justice system, we are doing our best to eat this elephant one bite at a time.”

RRH has come up with a temporary solution by offering assistance to those seeking to restore their original benefits with local clinics. “I know it’s not convenient for everyone, but we have simplified the process into a one-sheet form that our patients can fill out and allow us to pursue the change in service on their behalf,” said Whalley.

“We don’t have the authority to fix this on our own, but we know we have a moral obligation to advocate and fight for our patients. It’s the whole reason our Rural Health Clinics were established here.”

Whalley added that she is also hearing from patients who have Medi-Cal as a secondary insurance who have also been re-assigned to the Bakersfield network. “The number of local residents who have been impacted by this could actually be much higher than 10,000.”

Our Rural Health Clinics can help you: Call Adult Clinic (760-499-3855), Pediatrics (760-499-3846) or Southern Sierra (760) 446-6404